KENT BISHOP M.D. ProMedica Chief Experience Officer President Women s Service Line 1
WHEN A VISION TAKES SHAPE. 2
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4 Modern Facilities Clinical Service Lines Quality/ Safety Mental Health Clinical Research Satisfaction Cost Efficiencies & Transparency Information Technology Healthcare Medical & Professional Education Innovation College/ University Programs Education Housing Economic Development School Nursing Job Training Financial Opportunity Centers Personal Security Infant Mortality Hunger Summer Feeding Ebeid Institute SDOH Screening Staff Support Pharmacy Food Reclamation The Root Cause Coalition LISC/ Key Bank Green & Healthy Homes Lead Abatement EPIC Social Determinants Screening Downtown Generations Monroe Lenawee Health & Wellness CLINICAL EXCELLENCE SOCIAL DETERMINANTS ANCHOR INSTITUTIONS
OVERALL HEALTH DISPARITY Lucas County Overall Health Disparity Diabetes Hypertension (male) Obseity (female) Black White Smoking (male) Fair to poor health status 0 10 20 30 40 50 60 5
GOAL HEALTHY PEOPLE 2020 6.0 ALL RACES 16 OHIO INFANT MORTALITY RATES 14 RATES PER 1000 BIRTHS 12 10 8 6 4 2 0 ALL RACES WHITE BLACK HISPANIC 2013 7.4 6 13.8 8.8 2014 6.8 5.3 14.3 6.2 2015 7.2 5.5 15.1 6 2016* 7.4 15 *2016 rates are not projected and therefore not yet official 6
PHYSICIAN & PROVIDER BIAS Nationally 46% of providers admit to some racial bias It is found to lead to less time spent with the patient More importantly, it is felt to portend less involvement of the patient and their family in the decision making process 7
INFANT MORTALITY SCREENINGS Since implementation (April, 2015), 17,941 patients have been screened: OB, ERs and urgent cares And/or referred to the HUB from the community. Referred, 2992 Community Referrals, 690 3682 (21%) of screened patients resulted in HUB referrals Non-Referred, 14259 Screenings have since been expanded to include pediatrics and family medicine 8
INFANT MORTALITY SCREENINGS 300 250 200 150 100 50 0 Referrals By Month 272 229 223 206 195 174 164 152 141 143 146 137 128 124 120 153 142 95 99 91 126 118 103 73 57 41 12 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015 2016 2017 This can not be approached as a company project To be effective there must be commitment and a community collaboration There is not a single organization that can comprehensively effect the social determinants of health by themselves 9
INFANT MORTALITY SCREENINGS Age of referred patients 0% 0% The average age of referred patients is not what you might have guessed... 8% 4% 10% 32% 46% it is 26 years old 11-14 15-19 20-24 25-34 35-44 45+ Unknown 10
INFANT MORTALITY SCREENINGS Race Black White Hispanic Other Unknown Referrals by patient demographics 4% 5% 14% 38% Does your workforce and community resources align with the diversity in your community? 39% How will you create a culture of inclusion among your diverse community needs? 11
INFANT MORTALITY SCREENINGS n=3682 Food [VALUE] (47%) What your neighbors need might surprise you too. Mental Health Housing [VALUE] (24%) [VALUE] (36%) Baby Items [VALUE] (24%) 47% are food insecure 36% require mental health resources 24% are struggling with safe and secure housing 24% need basic baby supplies Tobacco Transportation Other Child Care Substance Use Insurance Domestic Violence [VALUE] (5%) [VALUE] (5%) [VALUE] (21%) [VALUE] (20%) [VALUE] (20%) [VALUE] (20%) [VALUE] (13%) Medication Assist [VALUE] (4%) 0 200 400 600 800 1000 1200 1400 1600 1800 2000 12
COMMITMENT TO IMPROVING INFANT MORTALITY The need Ohio s infant death per live births was 7.33 in 2014--well above the national rate of 5.93 Ohio infant mortality for African American babies was 14.3 in 2014 To address the issue, Pathways HUB was initiated and has shown great results Improvement African American women enrolled in Pathways had a lower rate of 9.5% in Lucas County Pathways referrals, community education, and physician awareness has driven the improvement Community health workers integral to care team 13
COMMITMENT TO IMPROVING INFANT MORTALITY 60% Cummulative Preterm and LBW 50% 40% 50% 50% 38% 39% 39% 30% 20% 25% 25% 38% 28% 32% 23% 21% 21% 22% 21% 20% 20% 18% 20% 19% 18% 18% 16% 16% 15% 16% 15% 15% 14% 14% 15% 15% 18% 18% 10% 14% 12% 12% 12% 14% 13% 13% 13% 13% 13% 13% 14% 13% 13% 14% 14% 14% 13% 0% May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 16-Oct 16-Nov 16-Dec 17-Jan 17-Feb 17-Mar 17-Apr 17-May 17-Jun Total % PT Cumulative % LBW Cumulative 14
LUCAS COUNTY INFANT MORTALITY RATES 25 LUCAS COUNTY RACIAL DISPARITIES 20 Interesting data emerging? 15 2016 black infant mortality rates by payer 10 Medicaid - 12.8 Private Insurance - 14.2 5 0 2013 2014 2015 2016 White Black *2016 rates are not projected and therefore not yet official 15
COMMITMENT TO IMPROVING INFANT MORTALITY Race Outcomes Enrolled More Than 90 Days 350 300 [VALUE] (89%) 250 200 [VALUE] (88%) 150 100 50 [VALUE] (89%) [VALUE] (12%) [VALUE] (11%) [VALUE] (11%) 0 Black n=193 White n=114 All Races n=338 HBW LBW 16
INFANT MORTALITY SCREENINGS Screenings Community Partners Links to Resources Self Empowerment Individuals Partners Referrals are made in a dignified manner Outcomes are improved with sustainability considerations Individuals enter this phase with varied degrees of readiness, often optimistically skeptical
The test of leadership is not to put greatness into humanity, but to elicit it, for the greatness is already there ~James Buchanan A TRULY INTEGRATED HEALTH SYSTEM FOCUSING ON THE SOCIAL DETERMINANTS OF HEALTH IS COMMITTED TO PARTNERING WITH ALL SOCIAL AGENCIES AND RESOURCES IN A GIVEN COMMUNITY 18
KENT BISHOP M.D. ProMedica Chief Experience Officer President Women s Service Line 19